High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study

doi:10.4253/wjge.v16.i12.668

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World Journal of Gastrointestinal Endoscopy

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World J Gastrointest Endosc. Dec 16, 2024; 16(12): 668-677
Published online Dec 16, 2024. doi: 10.4253/wjge.v16.i12.668

High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study

Masanori Ochi, Asaji Yamamoto, Satoshi Suematsu, Keita Fukuda, Kenjiro Morishige, Yasuhiro Oka, Yuta Ishikawa, Shunsuke Ueyama, Yoshinori Hiroshima, Yoshio Omae, Fumihiko Kusano, Toshiro Kamoshida

Masanori Ochi, Asaji Yamamoto, Yuta Ishikawa, Toshiro Kamoshida, Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan

Masanori Ochi, Department of Gastroenterology, Institute of Medicine, University of Tsukuba, Tsukuba 305-8576, Japan

Masanori Ochi, Department of Gastroenterology, Shoujukai Medical Association, Kiyosumi-Shirakawa Family Clinic, Tokyo 135-0021, Japan

Masanori Ochi, Hitachi Society Cooperation Education Research Center, University of Tsukuba, Hitachi 317-0077, Japan

Satoshi Suematsu, Department of Gastroenterology, Ome Medical Center, Tokyo 198-0042, Japan

Keita Fukuda, Shunsuke Ueyama, Fumihiko Kusano, Department of Gastroenterology, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan

Kenjiro Morishige, Yoshio Omae, Department of Gastroenterology, Kawasaki Saiwai Hospital, Kanagawa 212-0014, Japan

Yasuhiro Oka, Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo 113-8677, Japan

Yoshinori Hiroshima, Department of Gastroenterology, Hitachinaka General Hospital, Ibaraki 312-0057, Japan

Author contributions: Ochi M, Yamamoto A, Suematsu S, Fukuda K, Morishige K, Oka Y, Ishikawa Y, Ueyama S, Hiroshima Y, Omae Y, Kusano F, and Kamoshida T contributed equally to this work; Ochi M, Yamamoto A, Suematsu S, Fukuda K, Morishige K, Oka Y, Ishikawa Y, and Hiroshima Y collected and analyzed the data; Ochi M drafted the manuscript, designed and supervised the study; Yamamoto A, Suematsu S, Fukuda K, Morishige K, Oka Y, Ishikawa Y, Ueyama S, Hiroshima Y, Omae Y, Kusano F, and Kamoshida T offered technical or material support; and all authors have read and approved the final version to be published.

Institutional review board statement: This study was approved by the Institutional Review Board at each participating hospital [Hitachi General Hospital (2020-1), Tsuchiura Kyodo General Hospital (2022FY53), Kawasaki Saiwai Hospital (R4-7-2), Hitachinaka General Hospital (24-09), and Ome Medical Center (2024005)], and it was conducted in accordance with the ethical guidelines of the 1964 Declaration of Helsinki and its subsequent amendments.

Clinical trial registration statement: The study is registered in the University Hospital Medical Information Network Clinical Trials Registry under the identifier UMIN000041580. Details are available at https://www.umin.ac.jp/ctr/index-j.htm.

Informed consent statement: The participants were verbally explained the purpose, methods, safety precautions, and risks of the experiment prior to the commencement of the study, and all study participants provided written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The original anonymous dataset is available on request from the corresponding author at maochi-tei@umin.ac.jp.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Corresponding author: Masanori Ochi, MD, PhD, Doctor, Senior Lecturer, Department of Gastroenterology, Hitachi General Hospital, 2-1-1, Jonancho, Ibaraki 317-0077, Japan. masaochiphi@hotmail.co.jp

Received: July 24, 2024
Revised: September 16, 2024
Accepted: October 14, 2024
Published online: December 16, 2024
Processing time: 140 Days and 20.1 Hours

Abstract

BACKGROUND

Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD).

AIM

To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS).

METHODS

In this prospective study, PECS was characterized by in-hospital fever (white blood cell count: ≥ 10000 μ/L or body temperature ≥ 37.5 °C) and abdominal pain (visual analog scale score ≥ 30 mm during hospitalization or increased by ≥ 20 mm from baseline at admission). High Joule heat was defined as 15390 J. Between April 2020 and April 2024, 209 patients underwent colorectal ESD; those with intraoperative perforation or penetration were excluded. The remaining 202 patients were divided into the PECS and non-PECS groups.

RESULTS

PECS occurred in 30 (14.9%) patients. Multivariate analysis revealed high Joule heat as an independent factor associated with PECS (odds ratio = 7.96; 95% confidence interval: 2.91-21.8, P < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS.

CONCLUSION

Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset. This thermal damage is likely a major component of the mechanism underlying PECS.

Keywords: Colorectal tumors; Colorectal endoscopic submucosal dissection; Joule heat; Post-endoscopic submucosal dissection electrocoagulation syndrome; Thermal damage

Core Tip: This study demonstrated that thermal damage to the peeled mucosal surface during endoscopic submucosal dissection (ESD) is associated with the onset of post-ESD electrocoagulation syndrome (PECS). Analysis of 202 patients with colorectal ESD from April 2020 to April 2024 showed high Joule heat as an independent risk factor for PECS, occurring in 14.9% of the patients. Other factors, such as lesion location in the right colon and procedure time, were not associated with PECS. Accumulated thermal damage on the peeled mucosal surface likely plays an important role in PECS onset.